Job Summary

The Mgr, Risk and Quality Systems supports Molina’s Risk & Quality Solutions (RQS) team by overseeing daily operations, managing team performance, and driving achievement of goals. This role requires excellent leadership skills, strategic thinking, and the ability to communicate effectively with team members, cross functional departments, and senior management.
Manages a team of project and/or program managers and is accountable for a complex portfolio of data-improvement activities supporting Molina’s Risk & Quality Solution’s (RQS) program performance. Collaborates and communicates with various departments and stakeholders within Molina to plan, coordinate and manage resources and execute performance improvement initiatives aligned with RQS’s strategic objectives.

Job Duties

• Manages Risk and Quality Systems’ project and/or program managers and ensures team remains aligned with RQS strategies and goals.
• Supports the annual quality data submissions (NCQA and state regulatory submissions).
• Manages, designs, and develops data-focused strategies to improve completeness and accuracy of data ingestion activities including supplemental and HIE data.
• Collaborates with Risk & Quality leaders in RQS and health plans to improve program performance by supporting development of meaningful reporting and analytics including but not limited to: Risk/Quality rate trending and forecasting, provider Risk/Quality performance, CAHPS and other survey analytics, and health equity.
• Develops and maintains detailed and comprehensive project plans, schedules and assigns resources to ensure deliverables are timely, meet regulatory requirements, and are high quality.
• Identifies potential risks/barriers to project plans, etc. and develop mitigation strategies.
• Resolves complex problems through project management, data analytics, and stakeholder collaboration.
• Draws actionable conclusions, and makes decisions as needed while collaborating with other teams.
• Conducts regular reviews and audits to maintain high standards of performance.
• Addresses any issues or discrepancies promptly to ensure program success.
• Develops data quality strategies and solutions to close risk and quality care gaps.
• Communicate effectively and consistently with key stakeholders, including reporting risks and issues to stakeholders with recommended solutions.
• Prepares and presents regular status reports to stakeholders, highlighting progress, risks, and issues.
• Fosters a collaborative and high-performing team environment.
• Promotes professional development and knowledge sharing within the team.
• Mentors team members to develop their professional Risk/Quality expertise.

Job Qualifications

REQUIRED EDUCATION:

Bachelor’s degree or equivalent combination of education and experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 8+ years of program and/or project management experience in risk adjustment and/or quality
• 4-6 years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems
• 4-6 years of data analysis experience utilizing technical skillsets and resources to answer nuanced risk and quality questions posed from internal and external partners
• People management experience that demonstrates excellent leadership skills
• Expertise with running queries in Microsoft Azure or SQL server
• Mastery of Microsoft Office Suite including Excel and Project
• Significant healthcare experience and excellent risk adjustment and/or quality knowledge
• Accomplished history of partnering with various levels of leadership across complex organizations. 
• Comprehensive mastery of the drivers of value in managed health care as well as in-depth knowledge of the healthcare industry
• Expert-level ability to think cross-functionally, identifying cost/benefits to upstream and downstream stakeholders, and solutioning which sustains benefits to multiple groups and business areas
• Strong quantitative aptitude and problem solving skills
• Intellectual agility and ability to simplify and clearly communicate complex concepts
• Excellent verbal, written and presentation capabilities
• Energetic and collaborative
• Extensive knowledge and mastery of the nuances of healthcare claim elements: CPT, CPTII, LOINC, SNOMED, HCPS, NDC, CVX, NPIs, TINs, etc.

PREFERRED EDUCATION:

Graduate degree or equivalent combination of education and experience

PREFERRED EXPERIENCE:

• Experience supporting leadership and operating in a leadership role while working in a cross-functional, highly matrixed organization
• SQL mastery
• History of excelling in roles impacting both risk adjustment and quality

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, and/or comparable coursework desired

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.